Socio-economic status and trajectories of a novel multidimensional metric of Active and Healthy Ageing: the English Longitudinal Study of Ageing

Healthy ageing research largely has a unidimensional focus on physical health, negating the importance of psychosocial factors in the maintenance of a good quality-of-life. In this cohort study, we aimed to identify trajectories of a new multidimensional metric of Active and Healthy Ageing (AHA), including their associations with socio-economic variables. A latent AHA metric was created for 14,755 participants across eight waves of data (collected between 2004 and 2019) from the English Longitudinal Study of Ageing (ELSA), using Bayesian Multilevel Item Response Theory (MLIRT). Then, Growth Mixture Modelling (GMM) was employed to identify sub-groups of individuals with similar trajectories of AHA, and multinomial logistic regression examined associations of these trajectories with socio-economic variables: education, occupational class, and wealth. Three latent classes of AHA trajectories were suggested. Participants in higher quintiles of the wealth distribution had decreased odds of being in the groups with consistently moderate AHA scores (i.e., ‘moderate-stable’), or the steepest deterioration (i.e., ‘decliners’), compared to the ‘high-stable’ group. Education and occupational class were not consistently associated with AHA trajectories. Our findings reiterate the need for more holistic measures of AHA and prevention strategies targeted at limiting socio-economic disparities in older adults’ quality-of-life.


Supplementary materials Supplementary
Whether respondent has felt depressed much of the time during the past week b[2] Whether respondent felt their sleep was restless during the past week b[3] Whether respondent was happy much of the time during the past week (reversed)

b[4]
Whether respondent felt lonely much of the time during the past week b [5] Whether respondent enjoyed life much of the time during the past week (reversed) b

[6]
Whether respondent felt sad much of the time during the past week b [7] Respondent has taken a holiday in the UK in the last 12 months b [8] Respondent has taken a holiday abroad in the last 12 months b[9] Organisational membership: political party, trade union or environmental group b[10] Organisational membership: tenants or resident group or neighbourhood watch b [11] Organisational membership: member of a church or other religious group b [12] Organisational membership: member of a charitable association b [13] Organisational membership: an education, arts or music group or evening class b [14] Organisational membership: member of a sports club, gym, or exercise class b [15] Organisational membership: member of any other organisations, clubs, or societies b [16] Mobility: difficulty walking 100 yards (reversed) b [17] Mobility: difficulty sitting for about two hours (reversed) b [18] Mobility: difficulty getting up from a chair after sitting for long periods (reversed) b [19] Mobility: difficulty climbing several flights of stairs without resting (reversed) b [20] Mobility: difficulty climbing one flight of stairs without resting (reversed)

b[22]
Mobility: difficulty reaching or extending arms above shoulder level (reversed)

b[23]
Mobility: difficulty pulling or pushing large objects, like a living room chair (reversed)

b[24]
Mobility: difficulty lifting or carrying weights over 10 pounds, like a heavy bag of groceries (reversed) b [25] Mobility: difficulty picking up a 5p coin from a How often respondent goes to the cinema (reversed)

b[38]
How often respondent eats out of the house (reversed) b [39] How often respondent goes to an art gallery or museum (reversed) b [40] How often respondent goes to the theatre, a concert, or the opera (reversed)

b[41]
Whether has self-reported limiting long-standing illness ( How often respondent feels they lack companionship (reversed) Omitted a How often respondent feels left out (reversed) Omitted a How often respondent feels isolated from others (reversed) Omitted b Organisational membership: member of a social club Omitted b Blood HDL level (mmol/L) (dichotomised biomarker) Omitted b Blood triglyceride level (mmol/L) (dichotomised biomarker) Blood glycated haemoglobin level (%) (dichotomised biomarker) UK, United Kingdom; ADL, activities of daily living; IADL, instrumental activities of daily living; CRP, C-reactive protein; HDL, high-density lipoprotein; LDL, low-density lipoprotein. a These items were considered in the exploratory factor analyses but excluded from the final metric due to crossloadings (i.e., loadings >0.32 on more than one factor). b These items were considered in the exploratory factor analyses but excluded from the final metric as they did not load onto any factor (i.e., all loadings <0.25). Blood_HbA1c (biomarker) 0: ≥6.5 % 1: <6.5 % UK, United Kingdom; ADL, activities of daily living; IADL, instrumental activities of daily living; SD, standard deviation; CRP, C-reactive protein; HDL, high-density lipoprotein; LDL, low-density lipoprotein; HbA1c, glycated haemoglobin. a These items were considered in the exploratory factor analyses but excluded from the final metric due to crossloadings (i.e., loadings >0.32 on more than one factor). b These items were considered in the exploratory factor analyses but excluded from the final metric as they did not load onto any factor (i.e., all loadings <0.25). Notes: Participants who refused to answer or take part in a measured test or whose answers/scores were coded as "Don't know" were treated as missing cases. Reasons for not attempting a test that were independent of the participant (e.g., no suitable space/equipment, tests not timed correctly) were treated as missing cases. In addition, for biomarker data, samples that were a) not taken, b) not received by the lab, or c) unusable (e.g., too much time between data collection and receipt in the lab, unreliable measures, leaked sample, insufficient blood, unable to calculate the result etc.) were handled as missing cases. C-reactive protein values >20 mg/L were likely to reflect acute infection and were therefore treated as missing cases. For the composite measure of balance, scores were only calculated for participants with data on all three tests (i.e., side-by-side stand, semi-tandem stand, and full tandem stand). These items were considered in the exploratory factor analyses but excluded from the final metric due to crossloadings (i.e., loadings >0.32 on more than one factor). b These items were considered in the exploratory factor analyses but excluded from the final metric as they did not load onto any factor (i.e., all loadings <0.25). Notes: χ 2 = 8567.596, degrees of freedom = 1,766; RMSEA = 0.027, 90 % CI = 0.026-0.027; CFI = 0.963; TLI = 0.958. Four-factor solution corresponding to the EFA conducted on the developmental sample at baseline (n = 5,362). Bold denotes factor loadings higher than or equal to 0.25.  Four-factor solution corresponding to the EFA conducted on the developmental sample at baseline (n = 5,362). Bold denotes factor loadings higher than or equal to 0.25.